Assisted PD May Be a Safe Alternative to In-Center HD

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Assisted peritoneal dialysis and in-center hemodialysis are associated with similar hospitalization rates.

Assisted peritoneal dialysis (PD), which is a treatment option for patients who wish to receive dialysis at home but have significant barriers to self-care, is associated with a hospitalization rate similar to that of in-center hemodialysis (HD), researchers reported.

In a study comparing 203 assisted PD patients and 872 in-center HD patients, investigators found that the hospitalization rate was 11.1 days per year in the PD group and 12.9 days per year in the HD group, a non-significant difference, according to a paper published online ahead of print in the Clinical Journal of the American Society of Nephrology.

The study, led by Matthew J. Oliver, MD, of Sunnybrook Health Sciences Centre in Toronto, also showed that patients on assisted PD were more likely to be hospitalized for dialysis-related reasons compared with the HD group (admitted for 2.4 days per year vs 1.6 days per year). The difference was explained in part by more hospital days due to peritonitis. The PD patients had a hospitalization rate of 1.2 days per year for peritonitis whereas the HD group had a hospitalization rate of 0.4 days per year for catheter-related bacteremia, according to the investigators.

Modality switching was associated with high hospitalization rates in both groups. In the HD group, 179 patients (21%) transferred to PD after a median time of 136 days on HD. In the PD group, 51 patients (25%) transferred to HD after a median of 350 days, the investigators reported. Patients who transferred from PD to HD spent an average of 17.8 days in the hospital per year, and those who transferred from HD to PD had a rate of 17.7 days in the hospital per year.

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Dr Oliver’s team noted that assisted PD is a widespread therapy that expands home dialysis in the older population with barriers to self-care. “It seems to be a safe alternative to in-center HD in terms of hospitalization risk,” they wrote. “Peritonitis and technique failure are major drivers of hospitalization and should be monitored closely to maintain equivalent outcomes to in-center HD.”

In an accompanying editorial, Edwina A. Brown, MBChB, of Hammersmith Hospital in London, UK, and Martin Wilkie, MBChB, PhD, of Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK, said the new study “adds to the expanding literature on this fledgling dialysis modality [assisted PD] and supports its use as an alternative to in-center HD for people with barriers to self-care.”

With the population aging worldwide, growing numbers of older individuals are requiring dialysis, Drs Brown and Wilkie observed. “Assisted PD can avoid the need for transport, which not only adds to treatment times but is also disruptive to a person’s daily routine, particularly when considering the often antisocial hours of dialysis sessions.”